Kansas State UniversityOctober 2003Galichia Center on AgingPEAK Project Newsletter PEAK-EDThe Galichia Center is into the second year of the educational component of the two-pronged initiative sponsored by the Kansas Department on Aging and the Kansas Department of Social and Rehabilitation Services to Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK). In the coming year the PEAK-Ed staff at the Center on Aging will focus on creating the culture change guidebook. The first of the educational modules "Culture Change" and its companion piece "Measuring Change" are currently being piloted. Three new modules are being researched and prepared for dissemination. The first to be released will be about staffing issues, the next resident-centered care, and the third will focus on family and community connections. With the help of some of our faculty consultants we are also developing several mini-modules: Brain Gym or cross-lateral exercise for cognitive development, a second is based on environmental issues for aging, and a third is a companion piece to the family connections module. Each of the modules are based on adult learning styles research and are designed to provide experiential learning as well as written information. Pilot sites currently having access to the materials are required to implement one of the projects suggested in the module and are planning to evaluate the effects of the project. The quotes in this newsletter were taken from some of the older books in our library, demonstrating that nursing home culture change was being called for long before it became reality. The modules will be piloted in the following test sites:  Valley View Professional Care Center in Junction City  Medicalodge of Gardner  Plaza West Regional Health Center in Topeka  The Alzheimer's Center of Kansas City  Medicalodge of Leavenworth  Village Villa in Nortonville  St. Joseph Senior Community in Manhattan  Village Manor in Abilene  Mount Joseph Senior Village in Concordia  Rolling Hills Health Center in Topeka  Cornerstone in Pittsburg Shortly after the test sites have reviewed and implemented the materials they will be released through our web site to all nursing facilities and organizations. "These three things-visitors, privacy and personal possessions-have been shown repeatedly to be of great importance in the general satisfaction of nursing home residents. Homes which provide for all three appear to be meeting the needs of residents better than those homes which do not." Clyde Jones, former K-State professor, Caring for the Aged, 1982. PEAK-ED Advisory Group Speakers Outside presenters as well as faculty consultants to the PEAK initiative have enlivened discussion during past advisory group meetings. Gary Daniels and Carolyn Martin from Parsons State Hospital and Training Center in Parsons shared some of their experiences with change process in their organization. They pointed out that the time factor for change is slow and not to get discouraged early on. It took them three years just to get to the pilot stage for a dietary program change. Daniels stressed the importance in using pilot projects to demonstrate success as a way to garner support from staff. One of the ways that the staff learned to develop autonomy was through the decentralization of departments. When the cooks left the dining hall and went to the cottages through a "rush" program they were told that they could purchase their own food in town instead of through a distributor. This allowed creativity, the opportunity to make decisions, and increased the opportunities for residents to get out into the community. Daniels said that his test for truly empowering staff and residents was: "if I were a certified nurse aide and two residents wanted to go to the Dairy Queen, what would it take to do it?" Gary or Carolyn can be reached at Parsons State Hospital and Training Center. Migette Kaup, Assistant Professor at KSU in the Department of Apparel, Textiles, and Interior Design and a member of the PEAK-ED faculty consultant group, spoke about "Creating Culture Through Design." She used her work with Meadowlark Hills to describe how an organization can identify the "big" idea but then take "baby steps" to get there as funds allow. She showed slides demonstrating ways to transform large spaces, which can be difficult to control, to smaller, more intimate spaces. Dr. Kaup also discussed the need for a marriage of policy and environment. She ended her presentation with designing for private, semi- private and public spaces, an issue that is being considered by SAGE and KDHE as well as other groups interested in changing regulations to reflect new philosophies of care. Migette can be reached at 785-532-1317 or kaup@ksu.edu. "The image of the institution in the eyes of the community and the treatment accorded the residents affects the mental health of all old people who live daily with the knowledge that they too may some day need congregate care. Neglect or maltreatment of their institutionalized peers can only reinforce the anxiety with which older people and their families regard such a prospect even when there clearly is no alternative." Elaine Brody, A Social Work Guide for Long-Term Care Facilities, 1974. Sally Bailey, Assistant Professor at KSU in the Department of Speech Communications, Theater, and Dance, and a member of the PEAK-ED faculty consultant group, demonstrated, with advisory group participation, a couple of activities to use with residents and staff. The first, a brain awakening exercise using paper plates and music by Mozart, sparked discussion centered on replicating the movements in the morning and evaluating whether residents ate better or were more alert during another activity. There was additional discussion on ways to include the cross-body movements with residents (in activities such as dressing), and how to then evaluate the outcomes. The exercise might also help residents who are upset to become calmer. More information concerning the background of this activity as well as other resources can be found at www.braingym.com The second activity involved taping a melodramatic type radio show. The use of noise makers and improvised dialogue can initiate reminiscing, be taped as gifts residents can give to family members, or be enlarged upon to become a theatrical performance with costumes. Both of these activities could also be used with staff members for team building exercises. The Cracker Barrel carries tapes and CDs of old radio shows. Tapes are also available online at shop.crackerbarrel.com. Sally can be reached at 785-532-6780 or sdbailey@ksu.edu. Rick Scheidt, Professor at KSU in the Department of Family Studies & Human Service and a member of the PEAK-ED faculty consultant group, drew parallels between the successful aging movement and culture change. He said that the downside for long-term care is that "loss" is lacking in the successful aging model. A theory for culture change is also lacking, leaving a void in what types of combinations of residents and what types of environments or doses of interventions are necessary for successful implementation. Studies by Langer and Schultz that may have been early precursors of the culture change movement were also discussed. Dr. Scheidt's specialty is the effect of environments on aging. He most recently conducted research related to older adults living in Kansas ghost towns. Rick can be reached at (785) 532-1483 or scheidt@humec.ksu.edu. Brain GymWhen Sally Bailey, KSU professor in theater, visited the advisory group, she ignited an interest in cross-lateral exercise, called Brain Gym. These techniques were developed by Paul Dennison for what he calls, Educational Kinesiology. They focus on the performance of specific physical activities that activate the brain for optimal storage and retrieval of information. The web site (www.braingym.org/faq.html) goes on to describe this training as "a process for re-educating the mind/body system for accomplishing any skill or function with greater ease and efficiency." For the most part these exercises have been used within school classrooms to help students with problems. Only recently has anyone suggested an application for elders in nursing homes. One article, "The Effect of Brain Gym on Cognitive Performance of Alzheimer's Patients," is carried on the Brain Gym web site. The researcher's re-tested residents 45 minutes after receiving Brain Gym activities on their ability to repeat word lists, convert numbers, remember shopping list items, repeat a sequence of numbers backwards and repeat a word list. They noted an improvement of 23% as compared to a 3% improvement for residents in a control group who had not received any training. A number of the advisory group felt that implementing these types of activities might lead to more widespread outcomes including reduced incidence of weight loss and use of supplementation as well as improvements in physical ability. Currently the staff at PEAK-Ed are considering a small study to determine the effects of cross-lateral exercise in a nursing home setting. The following is an example of the articles submitted monthly to our website. If you wish to review these articles they can be found at www.ksu.edu/peak/researchtopractice.htm. Putting Research to Work Bakker, Rosemary, (2003) Sensory Loss, Dementia, and Environments, Generations, 27 (1), 46-51. Currently there are many articles being written about how environments should be designed for frail elders. Bakker's contribution is meant to be specific to dementia and sensory loss (hearing, sight, touch, smell and taste). Because so many nursing homes are considering changes in dining programs we have highlighted some of the article's suggestions for designing for loss of taste and smell. These losses can occur in residents who do not suffer from dementia and would be appropriate design accommodations for the entire home. "As a consequence of what is sometimes referred to as psychological railroading within highly routinized environments, some older residents are prone to a kind of institutional neurosis. Chief among its symptoms is a gradual erosion of the uniqueness of one's personality traits so that residents become increasingly dependent on staff direction for even the most mundane needs." Hendricks & Hendricks, Aging in Mass Society: Myths and Realities, 1986. It has been demonstrated that nutritional status can be affected by lighting, table and tableware, food choice and appearance, cueing and tablemates. Smaller dining areas may be preferable to avoid distracting noises. If the light is not bright enough and there isn't enough contrast between the table and the plates and silverware on it, residents may not be prompted to eat. Square tables rather than round help to define boundaries and may cut down on the possibility of people taking their neighbor's silver or cups. It may take some experimentation to find out what resident food preferences are. I remember listening in on a care-planning session where weight loss was a concern. It was discovered that the female resident being discussed, loved cinnamon and sugar on buttered bread. Staff members decided to keep these items available on the meal table at all times because this may be a treat that other residents may enjoy. Other tips include encouraging independence at mealtimes with verbal cueing ("Place the fork in your hand") and physical cueing (placing the fork in the person's hand). Offering finger foods to residents who have trouble manipulating utensils will allow the resident to continue to feel independent. Finding the right persons to sit together at tables is a critical factor. Seating assignments should be changed if residents become agitated and single tables should be used for those who prefer to dine alone. With a little attention to environmental factors you may be able to reduce weight loss problems.